Health Expectations

ObjectivesTrans and/or gender diverse (T/GD) people in the UK are less likely to access sexual health services (SHS) than cisgender people but are more likely to report negative experiences. The British Association for Sexual Health and HIV (BASHH) developed expert recommendations for T/GD-inclusive SHS, but these lack service user perspectives. This study addressed this gap by asking T/GD people how SHS could be T/GD-inclusive. MethodsSemi-structured interviews (n=31) and focus groups (n=21) were conducted with T/GD people aged 17-71 years old recruited through community organisations and social media, exploring experiences of SHS and inclusivity. Study design, materials, and analysis were informed by T/GD people and an advisory committee of charities and sexual health clinicians. Data were analysed using thematic analysis, managed using NVivo. ResultsParticipants often expected that SHS were not set up for T/GD people. This was reinforced by poor experiences in other healthcare settings and the lack of information on NHS websites. Some participants had been denied care because they were too complex. Participants wanted to know that SHS had engaged with the needs of T/GD people and looked for hallmarks of inclusivity, such as Trans Pride flags in reception areas. Some participants wanted specialist T/GD services, but others preferred to access general SHS. Staff attitudes were a key factor underpinning inclusivity. Anticipating having their identity questioned or needs dismissed, participants sought kindness and openness. Although the needs of T/GD people are diverse and different from cisgender service users, participants stressed that SHS staff already had the skills to deliver sensitive person-centred care and emphasised the value of inclusive SHS. ConclusionThese findings provide insight into what a sample of T/GD people in the UK consider important for T/GD-inclusive SHS. Participants suggestions aligned with and reinforce BASHH expert recommendations. Importantly, they highlight the need for ongoing engagement to deliver T/GD-inclusive SHS. Key messagesO_ST_ABSWhat is already known on this topicC_ST_ABSO_LITrans and/or gender diverse people are less likely to engage with sexual health services than cis-gender people C_LIO_LIThe British Association for Sexual Health and HIV (BASHH) Gender and Sexual Minority Special Interest Group (GSM SIG) has developed expert recommendations for trans-inclusive sexual health services, but user perspectives are missing C_LI What this study addsO_LIParticipant suggestions and preferences for inclusive services support BASHH GSM recommendations C_LIO_LIParticipants looked for inclusive SHS that recognise, understand and affirm their needs C_LI How this study might affect research, practice or policyO_LIEnhancing T/GD inclusivity involves active engagement with clinical spaces, processes and delivery C_LI

Cervical cancer is one of the top three cancers diagnosed in women globally. When women have access to a testing programme, abnormal cells can be detected to prevent the development of cancer. Research to date indicates that social and cultural barriers are the top two barriers in accessing cervical screening. In Ireland there may be a lack of trust in the National Cervical Screening programme due to previous mishandling of tests, and media coverage of the impacts of inaccurate screening results in Ireland. To understand impact of the health scandal on womens trust in cervical screening in Ireland, nine Irish women ages between 25-65 were interviewed. Data was thematically analysed using a feminist perspective to centre the womens voices in making sense of their appraisal and engagement with services. The data analysis resulted in four themes: Personal Reflections on Systemic Failure; Collective Concern and Blame; Decision Making Influencers and Rebuilding Knowledge and Trust. This analysis conveys distrust in the Irish Cervical Screening programme, feelings of anger, and a sense of neglect from the services. Irish women now place their trust in each other, the experience of their friends, families, their local GP. We discuss these finding to explore how Irish women have reinterpreted the narrative over the screening test in Ireland, and the potential to decrease concern around the topic by incorporating this experience into official narratives. This scandal heightened existing distrust and concern for the quality of womens screening services, and therefore has global relevance which can be applied to screening services more generally.

Over 300,000 children were born in the United Kingdom (UK) through assisted reproductive technology (ART). ART is associated with prematurity and congenital anomalies, while long-term health risks are currently considered low. Large-scale qualitative research exploring womens perspectives on these issues remains limited. Therefore, this study investigates womens concerns about health and educational outcomes following ART, and their views on information provision and national database studies. Women who underwent ART, were considering ART or conceived naturally were invited to participate voluntarily. An anonymous online survey was distributed via social media channels of a UK-based fertility charity and accepted responses for 8 months. Free-text responses underwent thematic analysis, and descriptive statistics were produced for categorical responses. Of the 562 participants, most were aged 25-40 (74.5%), White (93.2%) and held a degree or higher qualification (87.9%). The majority underwent ART through the private sector (42.3%) in the 2020s (69.1%) and had successful childbirth (52.4%). While up to 82.5% of respondents reported no health and educational concerns, others were concerned about reproductive, endocrine and hormone treatment-related cancer risks in themselves, in addition to potential reproductive, neurological and developmental issues in their offspring. Most participants (up to 91.9%) stated they received no information about ART-related health and educational outcomes in themselves and their child; those who did cited healthcare professionals or videos as sources. More than half (68.3%) supported using national databases to study childrens outcomes, and they expressed that such findings should be disseminated sensitively through healthcare professionals before treatment. Although most women reported no concerns or information about long-term health and educational outcomes for themselves or their children, many expressed concerns. The lack of information and support for database studies can inform patient-centred communication that addresses womens concerns. Future ART studies may consider incorporating patient and public involvement surveys to shape research priorities.

Remote consultations, including telephone, video, text or web-based consultations, are now common in sexual and reproductive health services (SRHS) in England and Wales, offering convenience and efficiency but raising concerns about safeguarding service users compared to in-person care. Ensuring protection and support for individuals remain central to SRHS. While guidance exists, evidence on how safeguarding is enacted remotely is limited. This study explores how safeguarding is managed in remote SRHS, examining associated challenges, benefits, and perceptions of acceptability. This qualitative study, part of the CONNECT study (NIHR153151), explored safeguarding in remote delivery of SRHS across three diverse case study areas in England and Wales. Semi-structured interviews were conducted with service users and providers (March 2024-January 2025). Data were thematically analysed using inductive and deductive approaches. Eighty-nine interviews were conducted with 54 service users/potential service users and 35 professional stakeholders across three study sites. Four key themes were identified: (1) challenges of delivering remote safeguarding in practice, (2) importance of a safe space for the patient, (3) one size approach does not fit all, and (4) strategies to support remote safeguarding. Participants described difficulties identifying risks without visual cues, variable comfort with disclosure, and privacy concerns. Providers used adaptive, collaborative approaches to build trust, ensure safety, and tailor safeguarding to individual circumstances. Both service users and providers recognised the effectiveness of remote safeguarding largely depended on clinician judgement, structured questioning, and sensitive communication. While remote consultations offered flexibility, remote safeguarding relied on service users having access to safe, private space. People with language barriers or those less able to create a safe space at home, such as those experiencing housing instability or coercive control may also have greater safeguarding needs. Ensuring access to in-person options, clear safeguarding protocols, and appropriate clinician training is essential to mitigate these challenges. Author summaryDuring the COVID-19 pandemic, sexual and reproductive health services used more remote appointments, such as phone, video, or online consultations. These appointments can make it easier for some people to get care. But there are concerns about whether staff can spot safeguarding issues, such as people who may be at risk of harm, without seeing them in person. In this study, we spoke with people who use sexual and reproductive health services, people who had never used these services before, and staff who work in these settings. People described challenges with remote appointments, including not being able to see body language, feeling unsure about talking about sensitive issues, and worries about privacy at home. Staff described changing how they worked by asking careful questions, building trust, and making safeguarding fit each persons situation. Both service users and staff felt that keeping people safe during remote appointments depends on clear communication and professional judgement. It is harder when people do not have a private space, face language difficulties, or live in unsafe housing or controlling relationships. Our findings show the importance of keeping in-person appointments available and making sure staff have the right training and guidance.

BackgroundRemote consultations (via telephone or video) were critical during COVID-19 restrictions for Sexual and Reproductive Health Services (SRHS) in England and Wales and continue to be implemented widely. However, there remains limited evidence on their impact on outcomes and health inequalities. This study, guided by the Framework for Digital Health Equity, explores the equity implications of remote sexual health consultations in England and Wales, examining their acceptability and appropriateness. MethodsWe conducted semi-structured interviews with 54 service users and potential service users and 35 professional stakeholders across three diverse case study areas. Participants were purposively sampled to ensure diversity in socio-demographic profile and service experience. All participants provided informed consent, and ethical approval for the study was granted by NHS Research Ethics Committee (REC: 23/NS/0128). Data were thematically analysed into narrative themes, with findings interpreted collaboratively with public and patient involvement groups. ResultsThe study found that remote consultations have reshaped care delivery, improving efficiency but also generating additional clinical workload and, for some clinicians, reduced job satisfaction. While generally acceptable, remote models were perceived to affect rapport, extend care pathways for some service users, and impact privacy and safeguarding. We found the benefits of remote consultation are unevenly distributed, with those experiencing digital exclusion, who lack access to suitable private spaces, or who experience language barriers, being less able to take advantage of their convenience. ConclusionsRemote consultations transform SRHS delivery, improving efficiency for some but introducing challenges by impacting interaction, equity, and confidentiality. Benefits and burdens are unevenly distributed, reflecting structural, social, and individual factors influencing access. SRHS must ensure equitable access to appropriate care for all populations when implementing remote consultations. The findings show that a one-size-fits-all approach is not appropriate, and that giving service users choice in how they consult, including in-person, is important.

PurposeTo explore mens assisted reproductive technology (ART) experiences, awareness and concerns about fertility-associated health outcomes, and perceptions of using administrative health records in the United Kingdom (UK) without consent to investigate these outcomes. MethodsOver a two-year period, all adult men were eligible to complete an anonymous online survey distributed via a UK-based fertility charitys social media. Free-text responses underwent thematic analysis, and categorical responses were analysed with descriptive statistics and Fishers exact test. ResultsAmong 80 participants, most were aged [≥]40 (66.7%), completed university (70.2%), White (77.2%) and UK residents (83.0%). Older (p=0.004) and White (p=0.001) men more likely underwent ART. Most ART users received treatment privately (60%) within the past three years (71.4%). Only one-fifth of the 15 men with identified fertility problems received discussion on fertility-associated health outcomes in clinic. Regarding perceptions, most were unaware of but concerned about these outcomes across biopsychosocial aspects, with participant quotes reflecting uncertainty and vulnerability. Recency of ART was associated with awareness (p=0.015) and concerns (p=0.001). Overall, 90.3% supported using administrative health records to investigate long-term health of fertility-challenged men, and 84.2% had no concerns about doing so without individual consent under established legal frameworks. Others raised concerns about the reliability of data anonymisation. Quotes suggested participants desire to understand the wider health implications of male fertility amidst a perceived gender imbalance in fertility research. ConclusionsGaps in participant knowledge, clinician communication and research in male fertility-associated outcomes support the need for universal education and further investigations in these outcomes. Capsule SummaryMost men showed limited awareness of but notable concern about fertility-related long-term health outcomes, and most supported using administrative health records without individual consent for investigating these outcomes.

BackgroundWomen with limited or no English proficiency experience persistent barriers to accessing maternity care in the UK, contributing to well-documented inequalities in maternal and perinatal outcomes. NHS parent education classes are predominantly delivered in English, and provision of multilingual classes within individual maternity units is often limited and duplicative. Evidence to inform collaborative, cross-trust service models remains scarce. ObjectiveTo assess womens access to, preferences for, and perceived relevance of NHS parent education classes, with particular focus on willingness to travel across London to attend classes delivered in a preferred language, in order to inform equitable and efficient service design. MethodsA cross-sectional, multilingual survey was conducted as a quality improvement initiative across multiple London maternity networks. The survey was translated into 18 languages and captured sociodemographic characteristics, access to parent education, preferences for delivery format, timing, location, and language, and perceived relevance of content. Quantitative data were analysed descriptively and thematically. ResultsA total of 97 women participated in the survey (n=97), the majority of whom reported speaking at least one non-English language at home (79.4%, n=77). Regarding mode of delivery, 51.6% of women preferred in-person parent education classes (n=50), 15.5% preferred online delivery (n=15), and 32.9% reported no preference (n=32). Most participants reported access to a suitable device and reliable internet (85.6%, n=83) and confidence using online platforms (77.3%, n=75). In relation to timing and format, weekends were the most commonly preferred time for classes (40.2%, n=39), followed by weekdays during school hours (35.1%, n=34) and weekday evenings (24.7%, n=24). Nearly half of women preferred delivery across two 2-hour sessions (48.5%, n=47), while 30.9% reported no preference regarding session length or number (n=30); fewer preferred two 3-hour sessions (11.3%, n=11) or a single 4-hour session (8.3%, n=8). Regarding willingness to travel, 67.0% of participants reported they would attend parent education classes delivered outside their booking maternity unit (n=65). Overall, 68.0% were willing to travel up to 45 minutes for in-person classes (n=66), while 29.9% preferred not to travel (n=29). With respect to language of delivery, 40.2% of women preferred classes delivered in their native language (n=39), and a further 40.2% reported English with an interpreter as acceptable (n=39); fewer were comfortable relying on a partner or friend to translate (19.6%, n=19). Most participants perceived that delivery by a native-speaking health professional would improve trust and learning (75.3%, n=73), and an equal proportion expressed a preference for a female interpreter (75.3%, n=73). ConclusionsWomen with limited English proficiency demonstrate clear willingness to travel across maternity networks to access antenatal education in their preferred language. These findings support the development of collaborative, cross-trust models that standardise core antenatal content while centralising multilingual provision, reducing duplication and improving equity of access across London maternity services.

BackgroundMost surveys examining health professionals knowledge, attitudes and practices around abortion have used convenience samples and have targeted doctors. Our goal in the SACHA Study, drawing on evidence-based strategies to maximise response rates, was to achieve a representative sample of a wider range of health professionals, working in general practice, maternity services, pharmacies, sexual and reproductive health (SRH) clinics and specialist abortion services in Britain, to explore the knowledge, attitudes and experience of abortion care and views on future models of delivery. MethodsA cross-sectional questionnaire-based survey of midwives, doctors, nurses and pharmacists in England, Scotland and Wales was undertaken between November, 2021 and July, 2022. We used a stratified cluster sampling approach to select a random sample of sites and all eligible staff within those services were asked to respond to the survey. Evidence-based strategies to maximise completion rates were adopted, including postal delivery of the one-page questionnaire with personal letter of invitation and a stamped address envelope for return, inclusion of an unconditional voucher and follow-up. ResultsOverall, 147 of the 314 (46.8%) health service sites randomly selected took part in the survey. Reasons for non-participation included local Research and Development (R&D) Department non-response, lack of resources or insufficient time to support or approve the study, lack of interest in or perceived relevance of the topic and insufficient capacity to take part, exacerbated by work demands during the COVID epidemic. Of the 1370 questionnaires sent to eligible identified participants within these services, 771 were completed and returned (56.3%). At the service level the highest proportion of returns was from SRH clinics (81.0%) and the lowest from general practice (32.4%). In relation to profession, returns were highest amongst midwives (69.6%) and lowest amongst pharmacists (36.5%). ConclusionsObtaining information about health professional knowledge, attitudes and practices is key to guide service development and policy and to identify gaps in training and service provision in abortion. Despite our attempts to gain a representative sample of health professionals, the challenges we experienced limited the representativeness of the sample, despite the use of an evidence-based strategy.

IntroductionThere is a lack of evidence to support clinical recommendations to delay cervical screening to 12-weeks postnatal. In previous studies, half of women were out of date for screening by the end of pregnancy and the majority would be more likely to take up cervical screening, if onered at the 6-week postnatal check-up. We explored views about postnatal cervical screening the acceptability of onering cervical screening, using conventional and urine self-sampling, earlier within the postnatal period. MethodsA cross-sectional qualitative design was used with recruitment from a larger questionnaire-based study. Twenty-six online semi-structured interviews were conducted with 26 pregnant or recently pregnant participants. Interviews were transcribed pseudonymised. A topic guide was developed, and data analysed using inductive reflexive thematic analysis. ResultsThree themes were generated from qualitative analysis of verbatim interview transcripts: 1) A window of opportunity; 2) Am I ready yet? Postpartum recovery; and 3) Neglect of womens health in and around pregnancy. Overall, there was a perception that womens health was not a priority in the postnatal period compared with their babies. ConclusionThis is the first study to use qualitative interview methods to explore womens views about the oner of cervical screening alongside the postnatal check-up. Results support the feasibility of a clinical trial to test the accuracy and enect on uptake of onering cervical screening at the postnatal check-up, although recognised it might be too soon for some. This should be considered in future feasibility research which includes assessment of concurrent acceptability. Patient or Public ContributionThis study was performed following focus groups in a quality improvement project, designed to increase uptake of cervical screening in women and people who were pregnant or recently pregnant. The suggestion for combining cervical screening with the routine 6-week postnatal follow up was an idea generated by new parents and GP practice stan. The Somerset Maternity Voices group provided feedback on study materials, including the consent form and posters. The semi-structured interview topic guide was designed following free-text comments in the pre-PINCS web-based survey, results of which are published separately. Female pregnant and recently pregnant people, regardless of current gender identity, were included in this study. In line with the Royal College of Obstetricians and Gynaecologists language guide, we will use women to describe participants. Practitioner PointsO_LIWomen recognise the importance of cervical screening, with an increased awareness of need of self-care for the benefit of their child, C_LIO_LIThere are increased practical barriers to attending screening as new parents and enorts to reduce barriers would likely improve uptake. C_LIO_LIWomen felt frustration around receiving mixed messaging and disinformation around cervical screening in and around pregnancy and would welcome a shift in focus to maternal care aspects at the postnatal check-up. C_LI

BackgroundMultiple barriers limit access to traditional in-person clinician sampling for cervical cancer. The STAMP (Screening with Tampons: Evaluating Diagnostic Accuracy for HPV and Assessing Participant Views) study evaluated the diagnostic accuracy and acceptability of tampon-based self-sampling for HPV amongst people assigned female at birth. Encouraging technical performance of the tampon as a sample for microbial detection was observed relative to clinician-taken samples. Pre and post trial questionnaires and a nested qualitative study explored acceptability. MethodsAll participants (n=263) completed questionnaires before and after sampling using three methods: tampon-based self-sampling, swab-based self-sampling, and clinician-collected samples. Questions included comfort, trust and ease of use of tampon-sampling. Four focus groups (n=24) were conducted online, and analysed using reflexive thematic analysis. ResultsQuestionnaire responses suggested tampon-based self-sampling was highly acceptable. Qualitative analysis identified four key themes: advantages of self-sampling over clinician-sampling; unique benefits of tampon-based self-sampling; concerns about accuracy and trust; and confidence in correct use. Participants valued the physical comfort, psychological ease, and practical convenience of self-sampling compared to clinician-sampling. The familiarity of tampons as an everyday product was central to acceptability, normalising screening. While some initially questioned accuracy, most were reassured by evidence of performance. Clear instructions and understanding the evidence base boosted confidence. ConclusionFindings suggest that tampon-based self-sampling is a highly acceptable alternative sampling approach for cervical screening that may increase screening participation by addressing multiple barriers. Implementation strategies should emphasise the methods everyday nature, while providing accessible guidance to support correct usage. What is already known on this topicO_LISelf-sampling for Human Papillomavirus (HPV) has been recommended by the World Health Organisation as an additional approach to expand cervical cancer screening services, complementing conventional clinician-taken sampling to broaden access and address barriers associated with in-person care. C_LI What this study addsO_LIFindings from this study suggest that self-sampling has the potential to support screening for cervical cancer as an acceptable, at-home approach addressing physical, psychological and practical barriers associated with traditional clinician collected sampling. C_LIO_LIParticipants reported that the familiarity of using a tampon for self-sampling creates a unique advantage over other self-sampling methods through demedicalising and normalising screening, therefore potentially increasing accessibility and participation among underscreened populations who experience most barriers. C_LI How this study might affect research, practice or policyO_LISelf-sampling including tampon-based self sampling offers a promising, acceptable approach to achieving cancer elimination goals. C_LIO_LIImplementation of tampon-based self-sampling for HPV should be clear, comprehensive and accessible, incorporating visual aids and simple language while emphasising the rationale and scientific evidence behind the collection method C_LI

BackgroundThe Transgender Clinic at the Kingston Health Sciences Centre (KTC) was created in 2017 to meet the needs of transgender patients. MethodsA retrospective review of all KTC patient charts was completed. The primary outcomes were the referral pattern to, and services provided by KTC. The secondary outcomes were the quality indicators i) rates of cervical screening and ii) offers of fertility preservation. Results108 patients were referred and 92 were seen; the median age was 20 years old. 77.2% of all patients sought, and 72.8% ultimately received, hormone therapy. Cervical cancer screening was documented as up to date for 69.8% of eligible people. 81.7% of eligible patients had documented fertility preservation offers. ConclusionAccessible local transgender care is a standard that can and should be met in Canada and internationally. O_LI77.2% of patients sought hormone therapy, which is in the scope of providers from many specialties C_LIO_LIAccessible local transgender care is a standard than can and should be met in Canada and internationally C_LIO_LIGynecologists, pediatricians, and primary care providers are well-suited to provide transgender care C_LI

IntroductionA Reproductive Life Plan (RLP) is a set of questions that encourage patients to reflect on their reproductive goals and the actions needed to achieve them. This scoping review of the published and grey literature aims to map the evidence on currently available RLPs. MethodsWe searched four databases (Medline, Embase, PsycINFO and Scopus) and used Google to search the grey literature, the search terms were; "reproductive life plan$" OR "reproductive plans$" OR "pregnancy intention screening". Data were extracted on target audience, format, content, behaviour change theory, features, effectiveness and acceptability. Results44 published papers and 18 grey literature sources were included. 21 RLPs were discussed in the published papers and 17 in the grey literature. Most RLPs came from the USA. Most RLPs in published papers were asked verbally, while all RLPs in the grey literature were self-completed; there were six digital RLPs. Most ask whether an individual wants children, some then ask about number and timing of children, and contraception. Grey literature RLPs also asked about lifestyle and health. DiscussionThe concept of developing an RLP is acceptable to people of reproductive age and healthcare professionals. There was a lot of consistency in the questions asked, however, there is limited data on effectiveness and only three tools, all digital, incorporated behaviour change theory. ConclusionA digital RLP that builds on the evidence for existing tools and integrates appropriate theory could result in the realisation of the potential that RLPs are theorised to deliver.

ObjectivesHistorically, contraceptive research is impeded by barriers to openly discuss sexual experiences. Theater-based research is a promising approach to foster deeper engagement and a richer exploration of lived experiences to gain insights in underlying implicit factors that shape contraceptive use. This study uses theater-based research to explore adults views, responsibility, satisfaction, and knowledge about contraception. Study DesignThe study was conducted at a three-day music festival in the Netherlands with 1,024 participants (32.9% men, mean age 28.1 years). Theater was integrated by transforming the study setting into a dance club, where the research team performed characters. Participants completed an individual survey prior to the theater experience, a team-based contraceptive knowledge quiz, and a writings on the wall activity. Survey and quiz data were analyzed using linear regression, thematic analysis was applied for evaluating writings on the wall. ResultsOn a scale from 1 to 10, the survey revealed general contraceptive satisfaction (women: 7.0, men: 7.7) and responsibility (women: 8.7, men: 7.7). Participant teams had a mean of 73.7% correct quiz answers. We found six themes that emerged in contraceptive views: side effects, fallibility, shared responsibility, information needs, dismissive counseling, and resistance to hormones. ConclusionThis study revealed complementary findings between traditional survey findings, indicating overall satisfaction with contraception, and theater-based writings on the wall, eliciting more candid and critical reflections with a notably negative tone. Theater-based data collection may capture lived experiences more vividly and lower barriers for research participation, suggesting its value for studying sexual and reproductive health. ImplicationsTheater offers a promising complement to conventional contraception research. By fostering comfort, humor and participation, it reveals more candid perspectives and may therefore reduce social desirability bias. Future research should further examine its added value in recruiting populations not reached by traditional methods.

BackgroundPregnancy preparation, to establish a healthy lifestyle within the preconception period, has been shown to reduce adverse maternal and neonatal outcomes. Despite its importance, we know very little about if and how people prepare for pregnancy in the UK. MethodsAs part of the P3 study, women in the UK were invited to complete an online survey about pregnancy preferences, including the Desire to Avoid Pregnancy (DAP) Scale. 274 participants were currently trying, thinking, or maybe thinking about getting pregnant and were asked about pregnancy preparations. The changes that women, and their partners, made in preparation for pregnancy, reasons for not preparing, and associations with sociodemographics were investigated in univariate and multivariate analyses. ResultsOf the 274 women, less than half (n=134, 49%) reported making any changes in preparation for pregnancy, with the most common changes being "eating healthier" (55%) and "folicacid" (54%). The main reason for not preparing was "only thinking about getting pregnant" (38%). 92 women answered questions about partner preparations; only 24% of partners were preparing, with the most common changes being "eating healthier" (64%) and "reducing alcohol" (50%). The main reason for partners not preparing was "already healthy" (51%). DAP score was the only significant factor affecting pregnancy preparation; every one- point increase in DAP score reduced the odds of a woman preparing for pregnancy by 78% (OR 0.22, 95%CI 0.15-0.34). ConclusionInterventions addressing pregnancy preparation for women, and their partners, are needed. These strategies should target women thinking about pregnancy, to ensure the full benefits of preconception care are received.

IntroductionWomen with a history of incarceration report higher rates of pregnancy, pregnancy terminations, and the use of Long-Acting Reversible Contraception (LARC) methods, alongside poorer birth outcomes compared to non-justice involved women, suggesting distinctive family planning needs. Despite this, little is known on how this is provided within carceral settings, or the structural barriers experiences by both staff and other service providers. In this article, we report findings from a qualitative study conducted with a sample of professionals working in New South Wales (NSW), Australia, who either provide healthcare services to women either during incarceration or in the immediate post-release period. Specifically, we describe structural factors that may impede or support access to the provision, insertion or removal of contraception devices. MethodsWe conducted semi-structured interviews with n=12 professionals, working in NSW, who either provide reproductive healthcare services to women during incarceration or in the immediate post-release period. Data was analysed thematically against the Vulnerable Populations Behaviour Model. ResultsSeven themes were identified relating to contraception service provision in prison. Participants observed specific patient characteristics which they believed were driving contraception needs including 1) a state of interrupted fertility caused by incarceration, and 2) post-release chaos which impeded access to appropriate family planning in the community. Areas of high need were characterised by 1) accessible, reversible and non-invasive contraception options, and 2) thoughtful counselling. Structural factors impeding contraception service access during incarceration included: 1) service priorities and staff biases negatively impacting access, 2) poor overall health service integration, and 3) inequitable funding models during incarceration. Consequently, incarcerated women do not have comparable access to contraception compared to women in the community. ConclusionThe lack of focus on contraception services in prison represents a missed opportunity to support highly marginalised women who may also face challenges accessing such services upon release.

In 2015, mifepristone, the international gold standard for medical abortion, was approved for use in Canada. Our content analysis of Canadian newspaper coverage describes arguments in favor or against medical abortion and the evolving regulatory framework for mifepristone from six months before approval until the last province included the medication as a publicly insured health benefit (2015-2019). Our study found an exceptionally high level of support for the approval, introduction and removal of regulatory barriers to mifepristone for medical abortion. Of 402 articles, 67% were pro-medical abortion, 25% presented balanced or neutral coverage and only 8% presented solely anti-medical abortion viewpoints. Of the 761 stakeholders cited, more than 90% made positive or neutral statements about medical abortion. Most articles discussed medical abortion as a health issue and contained arguments about how liberalization of the regulatory framework and public payment for mifepristone would improve abortion availability (68%), accessibility (87%), acceptability (34%) and quality (19%). Mifepristones introduction in Canada was presented in newspapers as a way to increase womens health, specifically in rural areas where disparities in abortion access exist. Rather than formal balance, which presents contrasting arguments as equally valid even when the scientific evidence for one vastly outweighs the other, our study identified evidentiary balance where coverage aligned with the majority of evidence and expert opinion. Our results differ from analyses in other high-income countries (United Kingdom, United States) that have found that media frame abortion as a stigmatized and controversial issue or mention abortion predominantly with respect to electoral politics rather than as a health issue. The Canadian print media presented overwhelmingly favorable arguments towards the expansion of mifepristone medical abortion and served to destigmatize abortion by framing the introduction and universal coverage of medical abortion as fulfilling core components of the right to health.

BackgroundFertility tracking apps have gained widespread popularity as a convenient method for women to monitor their menstrual cycles and improve chances of conception. Despite their prevalence, there is limited research synthesizing womens lived experiences and perceptions regarding the use of these apps. Understanding womens perspectives is crucial to address concerns about accuracy, privacy, and emotional well-being impacts, and to ensure that fertility apps are meeting the needs of their users. ObjectivesThis systematic review aims to synthesize qualitative research on womens perceptions and experiences of using fertility tracking apps. The review will explore womens attitudes, motivations, perceived benefits, and challenges related to the use of these apps. Specifically, it will identify key themes related to how these apps influence womens emotional well-being, relationships, and decision-making processes, while identifying gaps in current literature to guide future research. Methods and AnalysisThis review will consider qualitative studies that include women of reproductive age who have used or are currently using fertility tracking apps. The systematic review will be conducted in accordance with JBI methodology for systematic reviews of qualitative evidence using a meta-aggregative approach. A comprehensive search strategy will be employed across multiple databases, including PubMed, Web of Science, Embase, CINAHL, MEDLINE, The Cochrane Library, PsycINFO, and Scopus, from each databases inception to January 2025. Two independent reviewers will screen titles and abstracts using Covidence, assess full texts against inclusion criteria, and extract qualitative data using standardized tools. Study quality will be critically appraised using the JBI Critical Appraisal Checklist for Qualitative Research. Data will be analyzed using thematic synthesis following a three-step meta-aggregative approach: extracting findings verbatim, grouping similar findings into categories, and synthesizing categories into overarching findings. The certainty of findings will be assessed using the ConQual approach. DiscussionThis systematic review will provide the first comprehensive synthesis of womens experiences with fertility tracking apps, generating actionable insights for app developers, healthcare providers, and researchers. The synthesized findings can inform the development and refinement of fertility tracking apps to better meet user needs and preferences. Healthcare providers may benefit from these insights to guide patient discussions about fertility tracking and provide more tailored support. The identification of literature gaps will help direct future research efforts toward more diverse and inclusive studies on fertility tracking apps, ultimately contributing to improved womens reproductive health and well-being. PROSPERO registration numberCRD42025645316

BackgroundUsing programme theory we report a process evaluation of Accelerated Partner Therapy (APT) - a novel contact tracing (partner notification) intervention for people with chlamydia as part of the LUSTRUM trial. MethodsFollowing the specification and visualisation of initial programme theory, questions of context dependency, fidelity, and functioning of putative intervention mechanisms were addressed using deductive thematic analysis of qualitative data collected through focus groups and individual interviews with purposively sampled health care professionals (n=34 from ten sites), index patients (n=15), and sex partners who received APT (n=17). Analyses were independent of trial results. ResultsAPT was anticipated to change key interactions and sexual health service organisation to accommodate safe and optimal remote care. APT training and resources transformed key interactions as anticipated. Overall intervention fidelity was good and APT was well-liked by those who delivered and received it. Putative intervention mechanisms worked mostly as expected although those concerned with local implementation sometimes worked counter to expectations. APT and its trial struggled to be implemented at scale across all sites. Considerable pressures drove services to constantly adapt to achieve efficiencies. APT was perceived as time consuming without visible impact on perceived patient numbers in clinic curtailing positive feedback loops driving normalisation. DiscussionUsing programme theory we show an evidence-based, theoretically informed, overview of how APT worked dynamically within the context of the trial and within UK sexual health services. We find a mixed picture of a well-liked, intuitive, coherent intervention struggling to gain purchase within an already pressured service. Trial registrationISRCTN15996256 Study protocoldoi.org/10.1136/bmjopen-2019-034806 Ethical approvalThis study received ethical approval from London--Chelsea Research Ethics Committee (18/LO/0773). Findings will be published with open access licences. FundingThis work presents independent research funded by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research Programme (reference number RP-PG-0614-20009).

ObjectiveTo explore physical therapy experiences and identify barriers and facilitators of access to physical therapy for people who identify as trans, non-binary, or gender diverse (TGD). MethodsA qualitative descriptive design was employed using semi-structured interviews conducted in New Zealand. Participants were individuals aged 12 years or older, who self-identified as TGD, and had accessed physical therapy at a New Zealand clinic that provided a gender-affirming service. Participants were recruited via email invitation to the clinic database. Interview data were analysed using reflexive thematic analysis. Demographics are reported descriptively. ResultsSeventeen individuals participated. Four themes identified during analysis. Barriers to and facilitators of care were identified at policy, environmental, clinic and therapist levels. All participants reported physical therapy experiences relating to one or more of the following themes: challenging cisnormativity at policy, environmental, clinic and therapist levels; safety and trust throughout the clinical experience-including clinic credibility for being a safe provider, clinic displays of TGD-inclusivity, implementation of safe clinic processes, and respectful therapist interactions; inclusive experiences in a clinic which provided affordable care and took active steps to understand and affirm TGD identities, and physical therapists with a high level of knowledge of TGD-specific health issues and a biopsychosocial approach to care; and sensitivity to body discomfort or dysphoria triggers. ConclusionsPeople who identify as TGD face challenges to accessing safe and culturally sensitive physical therapy. However, there are achievable areas for improvement at policy, environmental, clinic and physical therapist level to gain trust and engagement in care for the TGD-community. Impact StatementThis study provides nuanced exploration of TGD physical therapy experiences and identifies specific areas of improvement for TGD physical therapy care to provide clinicians and physical therapy clinics insights into the provision of safe and culturally sensitive physical therapy.

ObjectiveTo identify psychosocial and cultural factors among Asian American patients diagnosed with infertility that may contribute to their disparate fertility outcomes. DesignA cross-sectional qualitative interview study was conducted with women [≥]18-years-old who identified as Asian American and had a diagnosis of infertility. Semi-structured interviews were performed until thematic saturation was reached. The interviews were transcribed and coded. A codebook was developed to capture the grounded perspectives of participants. The web application Dedoose was utilized to conduct content analysis, identifying common themes and patterns. ResultsAsian Americans voice the importance of having children, emphasizing the cultural expectation to procreate. They reported that infertility caused immense mental and emotional distress, resulting in feelings of disappointment and grief. Participants noted that it is not common in their culture to talk about infertility-related issues. Religion and naturopathic remedies played a large role in helping participants adjust to their infertility journeys. Participants stated that the infertility evaluation was complicated and one particular area of frustration was the lack of individually centered treatment. Interestingly, participants expressed desire to help other Asian women who are also struggling with infertility. ConclusionInfertility is a difficult and complex experience for Asian American women. Parenthood is a strong expectation for people of Asian descent and results in emotional burden when complicated by infertility. Fertility concerns are considered taboo to openly discuss, which can cause additional feelings of isolation. Healthcare providers should work to address the culturally induced shame associated with infertility and provide more individualized care.